COGNITIVE BEHAVIOR INTERVIEW AND OBSERVATION

Cognitive Behavior Interview and Observation

Cognitive Behavior Interview and Observation

Patient's Background

Melissa, an 18 year old girl was victim of a senseless brutal murder. The emotional pain and loss that surviving members experience do not go away as attested to by the survivors of the events of September 11. The question for patients is how to muster the courage and to transform their emotional pain into something good that will come of it. As I discuss in some detail becomes a personal directive; for forgetting would dishonor the memory of the lost one. Instead, how individuals use the memory of the loss to make changes is a task of therapy. In Melissa's case, her parents helped establish an Institute in her name. If they could prevent one more Melissa from dying, then maybe she did not die in vain. Patients do not need to create an Institute to heal. Their Institute may be a small personal way to "find meaning". This constructive narrative perspective that I am advocating is not unique to cognitive-behavior therapy. A number of psychodynamic therapists such as Schafer and Spence have been strong advocates of a narrative perspective, as has the developmental psychologist Jerome Bruner.

Interview and Observation

During the interview, we began to realize that in addition to the thoughts Melissa revealed during free association, they often had another stream of thoughts that they did not report very often. Melissa spent a session regaling our father with her sexual exploits. At the end of the session, she said that she had felt very anxious during the session because she thought that our father had found her boring. This led to the idea that people can have two concurrent levels of thinking. In addition to a more volitional level of thinking, there is often an automatic level of thinking. That is, evaluative thoughts that spontaneously arise in people's minds. Upon inquiry, we found that depressed patient Melissa reported the same type of stream of thought. In fact, when we began to examine our own and others' thinking, we found that everyone has this automatic level of thinking from time to time. we discovered that our depressed patient Melissa often had automatic thoughts that were highly negative and distorted. These Melissa tended to see themselves as failures, helpless, worthless, and unlovable.

Melissa is unaware of their automatic thoughts before they come to treatment. Frequently, they are more aware of the emotions or behavioral reactions that their automatic thoughts lead to. However, almost Melissa can be easily taught to identify their automatic thoughts. At the Beck Institute, we explain to Melissa that when they are depressed it is almost as if they are wearing black glasses, so that everything that they see looks dark. We ask them to notice when their mood changes (or when they are engaging in dysfunctional behavior) and to ask themselves what is going through their minds. Then we teach Melissa to test the validity and utility of these ...